Minilaparotomy: A Minimally Invasive Alternative for Major Gynecologic Abdominal Surgery

https://doi.org/10.7812/TPP/04-107

Introduction

In the 1960s or 1970s, gynecology residency training emphasized vaginal hysterectomy as the preferred technique for treating many conditions now managed by less invasive alternatives. This led gynecologists to become very skilled at operating through very small incisions. More recently, as these less invasive procedures are rapidly becoming the standard of care, and women are having fewer babies, vaginal surgery is performed less often. Because our young colleagues are acquiring less experience with this technique, the skill of operating through a very small incision is becoming a lost art. Of the 600,000 hysterectomies done in the United States each year--a number which has remained stable for the past 20 years--65% to 75% are done through large abdominal incisions.1 Rates in the Kaiser Permanente Northern California (KPNC) Region are somewhat better: The rate of abdominal hysterectomy is 68%, the rate of vaginal hysterectomy is 21%, and 11% of these procedures are done laparoscopically.